CPCS Practice Test Questions, all Solved 100%
Correct| Verified Answers
Q - The basic or "core" criteria most often associated with applications for medical staff
appointment or participation in MCOs are reflective of __________. - ✔✔A - Education,
training, current competence, health status, and licensure.
Q - Core criteria should be clearly outlined in _________. - ✔✔A - Bylaws, policies, and/or
rules and regulations.
Q - External criteria for membership are requirements set by these forces: - ✔✔A -
Accrediting and certifying bodies such as TJC, HFAP, DNV-GL, AAAHC, NCQA or URAC, state and
federal regulations such as the Medicare CoPs, and state licensing laws.
Q - The following criteria are considered what? Board certification, an office within a prescribed
geographic distance from the institution, alternate coverage, residence within a prescribed
geographic distance from the hospital, need for a particular specialty, application fee, minimum
amounts for professional liability insurance, etc. - ✔✔A - Internal criteria.
Q - Who sets internal criteria? - ✔✔A - The hospital's medical staff and governing board or
the MCO's board and credentialing committee.
Q - Under a typical hospital medical staff _____ includes licensed physicians and other licensed
individuals permitted by law and by the hospital to provide patient care services independently
in the hospital. - ✔✔A - LIPs
Q - Who decides whether practitioners will be allowed to practice independently within the
institution and, if so, whether they are eligible for medical staff membership/appointment
and/or privileges? - ✔✔A - The hospital and/or medical staff - internal.
,Q - Who states that the governing body must appoint members of the medical staff after
considering the recommendations of the existing members of the medical staff? - ✔✔A -
Medicare CoPs
Q - Who states that the governing body must ensure the criteria for selection are individual
character, competence, training, experience, and judgment? - ✔✔A - Medicare CoPs
Q - Who requires the hospital, based on recommendations by the organized medical staff and
approval by the governing body, to develop criteria to be used in making decisions to grant,
limit, or deny a requested privilege? - ✔✔A - TJC
Q - Who states that Medical staff membership and professional privileges cannot be dependent
solely upon certification, fellowship, or membership in a specialty body or society? - ✔✔A -
TJC
Q - Who states that the criteria for membership and the credentialing process be defined in the
medical staff bylaws and that this process must be followed? - ✔✔A - TJC
Q - Decisions on membership and granting of privileges must consider criteria directly related
to the quality of health care, treatment, and services is required by whom? - ✔✔A - TJC
Q - This entity allows hospitals and medical staff to utilize other supplemental membership
criteria such as geographic location or maintenance of a certain amount of medical liability
insurance. - ✔✔A - TJC
Q - Under _____ bylaws or an appended credentialing manual must describe the qualifications
and criteria a candidate must meet for the medical staff to recommend that he or she be
appointed and granted privileges by the governing body. - ✔✔A - HFAP
Q - _____ requires that all practitioners providing a medical-related level of care or who
conduct surgical procedures either directly or under supervision must be individually evaluated.
- ✔✔A - HFAP
, Q - This entity requires all practitioners be individually evaluated regardless of whether they are
employed by the hospital, independent physicians, or contracted. - ✔✔A - HFAP
Q - Who requires a credentialing procedure manual or bylaws to describe the levels of non-
physicians allowed to provide services in the facility? - ✔✔A - HFAP
Q - Under _____, the governing body determines, in accordance with state law, which
categories of practitioners are eligible candidates for appointment to the medical staff. -
✔✔A - DNV-GL
Q - Under _____, the organization's credentialing and recredentialing policies must explicitly
define the process used and the criteria required to reach a credentialing decision. - ✔✔A -
NCQA
Q - NCQA requires the health plan / MCO's policies and processes include what? - ✔✔A -
Practitioner types; verification sources; credentialing and recredentialing criteria; decision-
making process; management of credentialing files that meet the criteria;
Q - Under _____, notification to practitioners is required when credentialing information
obtained varies significantly from the information provided. - ✔✔A - NCQA
Q - Who requires notification to practitioners of credentialing and recredentialing decisions
within 60 calendar days of the decision? - ✔✔A - NCQA
Q - This entity requires the roles and responsibilities of the medical director or other designated
physician's be included in the credentialing program; a statement regarding the confidentiality
of all information obtained during credentialing process, except as otherwise provided by law;
and consistency of practitioner directories. - ✔✔A - NCQA
Correct| Verified Answers
Q - The basic or "core" criteria most often associated with applications for medical staff
appointment or participation in MCOs are reflective of __________. - ✔✔A - Education,
training, current competence, health status, and licensure.
Q - Core criteria should be clearly outlined in _________. - ✔✔A - Bylaws, policies, and/or
rules and regulations.
Q - External criteria for membership are requirements set by these forces: - ✔✔A -
Accrediting and certifying bodies such as TJC, HFAP, DNV-GL, AAAHC, NCQA or URAC, state and
federal regulations such as the Medicare CoPs, and state licensing laws.
Q - The following criteria are considered what? Board certification, an office within a prescribed
geographic distance from the institution, alternate coverage, residence within a prescribed
geographic distance from the hospital, need for a particular specialty, application fee, minimum
amounts for professional liability insurance, etc. - ✔✔A - Internal criteria.
Q - Who sets internal criteria? - ✔✔A - The hospital's medical staff and governing board or
the MCO's board and credentialing committee.
Q - Under a typical hospital medical staff _____ includes licensed physicians and other licensed
individuals permitted by law and by the hospital to provide patient care services independently
in the hospital. - ✔✔A - LIPs
Q - Who decides whether practitioners will be allowed to practice independently within the
institution and, if so, whether they are eligible for medical staff membership/appointment
and/or privileges? - ✔✔A - The hospital and/or medical staff - internal.
,Q - Who states that the governing body must appoint members of the medical staff after
considering the recommendations of the existing members of the medical staff? - ✔✔A -
Medicare CoPs
Q - Who states that the governing body must ensure the criteria for selection are individual
character, competence, training, experience, and judgment? - ✔✔A - Medicare CoPs
Q - Who requires the hospital, based on recommendations by the organized medical staff and
approval by the governing body, to develop criteria to be used in making decisions to grant,
limit, or deny a requested privilege? - ✔✔A - TJC
Q - Who states that Medical staff membership and professional privileges cannot be dependent
solely upon certification, fellowship, or membership in a specialty body or society? - ✔✔A -
TJC
Q - Who states that the criteria for membership and the credentialing process be defined in the
medical staff bylaws and that this process must be followed? - ✔✔A - TJC
Q - Decisions on membership and granting of privileges must consider criteria directly related
to the quality of health care, treatment, and services is required by whom? - ✔✔A - TJC
Q - This entity allows hospitals and medical staff to utilize other supplemental membership
criteria such as geographic location or maintenance of a certain amount of medical liability
insurance. - ✔✔A - TJC
Q - Under _____ bylaws or an appended credentialing manual must describe the qualifications
and criteria a candidate must meet for the medical staff to recommend that he or she be
appointed and granted privileges by the governing body. - ✔✔A - HFAP
Q - _____ requires that all practitioners providing a medical-related level of care or who
conduct surgical procedures either directly or under supervision must be individually evaluated.
- ✔✔A - HFAP
, Q - This entity requires all practitioners be individually evaluated regardless of whether they are
employed by the hospital, independent physicians, or contracted. - ✔✔A - HFAP
Q - Who requires a credentialing procedure manual or bylaws to describe the levels of non-
physicians allowed to provide services in the facility? - ✔✔A - HFAP
Q - Under _____, the governing body determines, in accordance with state law, which
categories of practitioners are eligible candidates for appointment to the medical staff. -
✔✔A - DNV-GL
Q - Under _____, the organization's credentialing and recredentialing policies must explicitly
define the process used and the criteria required to reach a credentialing decision. - ✔✔A -
NCQA
Q - NCQA requires the health plan / MCO's policies and processes include what? - ✔✔A -
Practitioner types; verification sources; credentialing and recredentialing criteria; decision-
making process; management of credentialing files that meet the criteria;
Q - Under _____, notification to practitioners is required when credentialing information
obtained varies significantly from the information provided. - ✔✔A - NCQA
Q - Who requires notification to practitioners of credentialing and recredentialing decisions
within 60 calendar days of the decision? - ✔✔A - NCQA
Q - This entity requires the roles and responsibilities of the medical director or other designated
physician's be included in the credentialing program; a statement regarding the confidentiality
of all information obtained during credentialing process, except as otherwise provided by law;
and consistency of practitioner directories. - ✔✔A - NCQA
